If you could read my mind (Musings on hard-to-believe TM news)

Updated: 7 July 2014

June's blog is another take-off on cartoonist Gary Clement's weekly feature, 'Week in Review' in Canada's National Post, e.g., Week of May 18-24, 2014. They capture the week's news with a smile.

The blog's title derives from an old Gordon Lightfoot song that has been covered by many artists.

Topics include an eclectic selection of recent news items in TraQ's newsletter. All four have a whiff of unbelievability. Since some aspects seem unbelievable, my treatment of the stories is irreverent.

Also see my latest BBTS blog:

• Do you believe? (Musings on cloud-based software services by a transfusion medicine techno heretic)

1. This is kinda gross (and does it work?)

• India: Goat blood enema used to help treat thalassemia patients (8 June 2014) 

The principal investigator said the enemas ensure hemoglobin levels do not go down drastically and research has proved it. Cases existed in which patient blood transfusion needs were reduced to half or even less.

I couldn't find the research in PubMed, but, if you can, let me know. Patient blood management is the flavour of the year as evidenced by the number of papers in TM journals and May's issue of AABB News:

• 'Patient blood management hits prime time' (Content under 'Departments' in left menu is free)

According to the CEO message, AABB recently published Standards for a Patient Blood Management Program plus launched a new PBM consulting program. Indeed, no doubt smelling the ka-ching potential, AABB created a new PBM section on its website.

Perhaps all the blood management consultants aiming to make big bucks should wake up and smell the sheep dung?

2. This is turning a blind eye (or protecting one's butt?)

• Australia: NBA downplays Jehovah's Witness not declaring potential conflicts of interest to sit on transfusion guidelines panel (2 June 2014)

Australia's National Blood Authority (NBA), a well respected government organization that does much valuable work, appointed Shannon Farmer, a Jehovah's Witness, as the key consumer representative on a government panel developing new transfusion guidelines for Australia's hospitals. Nil inappropriate about that except Mr. Farmer didn't declare

• Formally, or otherwise it seems, that he was a Jehovah's Witness. 

• His consultancy work since 2007 to an Austrian business involved in commercial tendering for patient blood management projects around the world.

• Receiving fees for consulting and lecturing from multinational pharmaceutical companies,e.g., J and J.

When informed, the NBA said it would review the details. Whether or not possible conflicting interests are of "sufficient conflict" is a moot point. 

Fact is they were not declared and at the time of his appointment Farmer was described as "consumer" and "independent consumer advocate". An NBA spokesperson is quoted as saying, "The NBA believes any potential conflict of interest, real or perceived, should be declared."

So far as I can tell Shannon Farmer is not a physician nor a PhD researcher, yet:

• He's an Adjunct Research Fellow, School of Surgery, at the University of Western Australia, where he's listed as an author on multi-authored papers about blood. 
• LinkedIn shows he's an Adjunct Senior Research Fellow Centre for Population Health Research, Curtin University.
• He's lectured extensively on bloodless surgery and blood conservation.  
• He's apparently an expert on transfusion medicine.

Yet it's hard to discover which degrees he has, where he went to school, or any of the normal qualifications of someone who's an author, lecturer, and expert on TM, with university appointments.

And none of the above profiles even hint that he's consulted for years to Austria's 'Medicine and Economics' business involved in commercial patient blood management projects globally.

How can you not know that someone you appoint to panels developing national blood transfusion guidelines is a member of a religion that forbids transfusion and earns big bucks implementing blood management programs internationally? How can you say, when information comes to light, 'These aren't sufficient conflicts'?

Isn't this equivalent to someone being appointed to a government panel on the future of private laboratories in Alberta (Canada, UK, you name it)

• Who is a member of a political party whose policies are pro-private medicine (pro-private everything)?
• Who consults for (perhaps partially owns) a private laboratory consortium bidding for government contracts?

Sorry, the non-physician Jehovah's Witness as TM expert and global blood management consultant who advises on transfusion guidelines, didn't declare potential conflicts, makes millions off blood management, and was initially listed as a consumer and consumer advocate doesn't meet the sniff test. 

Or...he's a fine fellow, does good work, and the NBA thinks it's okay that he didn't declare potential conflicts, despite their policies, because the conflicts are not serious ones?

3. This is glimpse into murky reality of paid plasma (and is it real?)

• USA: Twisted business of donating plasma for money (28 May 2014)

You know from past blogs that I'm against paid plasma clinics in Canada. But this account of paid plasma centers in the United States seems unbelievable. Examples (paraphrased):

Albuquerque's Yale Plasma, on a strip where panhandlers convene, resembles a pawn shop. 

CSL Plasma has no chairs. Donors crouch on the floor or stand in long lines until they plass. Asking a young man if he minded squatting, I’m told CSL removed the complementary seating to “keep the bums out of here.”

[Yale Plasma is part of DCI Biologicals. The center (pic via Google) is close to both a university and community college. Note 'Earn Big Cash' in window.]

Ron, an unemployed schoolteacher began regularly plassing 6 years ago to make ends meet for his new son. He was disqualified at a local center because he had many visible tattoos but accepted at another “that was less picky.”

At a CSL center “Bubba” said he was homeless and an alcoholic and had been plassing for nearly 15 years with no ill effects other than "sometimes my arm hurts really bad." He says he was unhappy when he drank too much to pass the protein level test, but claimed he later discovered, “If I swallow ketchup before going in I can pass any test they throw at me.”

For interest CSL is Australia’s chosen national plasma fractionator and under contract to Australia’s NBA.

This report of paid plasma centers seems unbelievable. Tattoos, donors crouching on floors, 'Bubbas' swallowing ketchup and thinking it tricks tests to measure plasma protein levels? On the other hand, You can't make this stuff up. Real life trumps fiction?

4. This is how to discourage feedback (mimics Health Canada on how to get feedback on paid plasma?)

The Canadian Standards Association (CSA) recently sent a notice via the CSTM that it seeks feedback on

•  Blood and Blood Components, Draft 3rd ed. (Public review to 25 July, 2014)

I assume that when health or government organizations want feedback on things like transfusion guidelines, they make it easy for users since professionals are busy people. Whenever giving feedback is more difficult that it need be, several possibilities exist:

1. Feedback isn't really wanted. 
2. Feedback is wanted but the organization's convenience is placed above that of the users from whom feedback is asked.
3. Those responsible for obtaining feedback for the organization are incompetent.

How does the way the CSA asked for feedback on Blood and Blood Components, Draft 3rd ed. strike you? Here's what I experienced:

First, the CSA notice of the third draft (dated 15 May 2014) and how to access it, was sent to CSTM members on 28 May 2014. How the 2-week delay occurred is unknown (but not critical).

Second, to access the draft, you must register (provide a valid e-mail address and password).

Third, you must confirm your e-mail address. This allows you to access and print your comments and to resume commenting later.

Fourth, presumably your identity can be tracked. If curious, CSA has a Privacy policy but it requires work to find:

• Find and then click on Terms of Use, which is at the bottom of the page, then scroll all the way to the bottom of the next page to the last paragraph and click on Privacy:
• With respect to the collection, use and disclosure of personally identifiable information, please see Privacy.  By using the Site, you consent to having CSA Group contact you in connection with additional draft standards that may be available at the Site. If you do not wish to be contacted, you may opt out by sending an email publicreview2@csa.ca. If you choose to opt out, you may lose some of benefits of which are associated with use of the Site.

Then on the NEXT (now 3rd page), you get to CSA Group Web Site Privacy Statement.

Fifth, there is no way to download the entire document. Instead you must access each section of the document on the website and submit comments separately for each of 23 sections, plus 5 tables and 2 annexes. And each section has multiple parts and sub-parts. 

As an example, section 4 alone (General) has spots for ~90 Comments, each of which must be clicked on to submit comments. Hmmm.... 

• Alert: Expect digit finger to suffer from repetitive stress injury. Feel free to bill CSA for any lost productivity or needed splints? 

Sixth, apparently 60 days is the time used by CSA for obtaining feedback. But having the 60 days occur in June and July when many Canadians are on vacation seems perverse. 

Do you believe CSA truly wants maximum input from users into its blood standards? If yes, then possibility 2 or 3 above must be in play, ie., either it's all about them (not you) or they're incompetent.

Perhaps Health Canada is the role model for CSA? We know how HC tried its best to get feedback from Canadians on paid plasma clinics: 

• Day tripper (Musings on HC's instructions to the jury on paid plasma)

Added 7 July 2014
Anonymous (see below) added an update to Canada's paid plasma saga:

• Re-elected Ontario govt plans to ban paid plasma clinics

It's a battle of the pro-business federal Conservatives with Canadian Blood Services and Health Canada as their surrogate poodles.

I'm aware of the case for paid plasma but it's wrong for Canada. If paid plasma is good, why not paid red cells, stem cells, and organs like kidneys, etc.

And don't bring up the Cangene case in Winnipeg where paid plasma has long existed. I was there (Canadian Red Cross) at the beginning. Paying women for their plasma containing potent anti-D, who had fetuses die of Rh hemolytic disease of the fetus and newborn, is so NOT like paid plasma clinics in the USA and what Canadian clones propose by setting up shop next to homeless shelters.

FOR FUN
Some aspects of each item seem unbelievable:

• Goat blood enemas are effective in preventing anemia in thalassemia patients?
• Australia's NBA didn't know about potential conflicts of a key consumer rep on a government panel developing transfusion guidelines and then didn't care?
• Paid plasma clinics in the USA, one of which (CSL Behring) is a major supplier to Australia's NBA, 'plasses' homeless alcoholics and offers no chairs for donors waiting to be bled?
• Canada's CSA wants input so much it opts for feedback on the 3rd ed. of Blood and Blood Components that requires users to give feedback over June and July and enter data into 100s and 100s of web-based forms? 

What do you think about all this? For me, a song by Canada's Gordon Lightfoot comes to mind:

• If you could read my mind 

If you could read my mind, love
What a tale my thoughts could tell....

As usual, comments are most welcome.